gms | German Medical Science

Background: Inguinal hernia repairs are one the the most common operations in General surgery. Surgical procedure depends mainly on the individual surgeon experience, patients general condition and history. Influence of surgical technique on inguinal pain has not been investigated yet. Therefore, we aimed to systematically compare one laparoscopic technique (transabdominal preperitoneal, TAPP) with one open (Lichtenstein) repair.

Materials and methods: We prospectively analyzed 48 patients with inguinal hernia in the University Hospital of Mainz, Germany from August 2011 till April 2013. For TAPP a self-fixating ProGrip^TM mesh and for Lichtenstein repair an ULTRAPRO^TM mesh were used. 29 patients received Lichtenstein repair (median age 73 years, 28 men), 19 patients received TAPP repair (median age 58 years, 18 men). Nine patients in the TAPP group received herniotomies of both sides. Data concerning pre- and postoperative (a) pain and paraesthesia, (b) restriction of motion and exercise capacity. For evaluation interview bows including a standardised pain score (Pain Research Group Department of Neurology – University of Wisconsin-Madison Medical School) were used. Data were collected at the time of operation preparation and one months after operation.

Results: In cases with preexisting inguinal pain, patients after Lichtenstein repair showed a significant reduction of pain strength (p=0.024), compared to patients after TAPP procedure (p=0.498). Moreover, inguinal general activity, ability to work and sleep impaired by pain improved after Lichtenstein repair. Whereas, TAPP procedure showed no influence on pain impairment. Comparing both techniques: The mean duration of the hospital stay was 2.4 days for the Lichtenstein group vs. 2.1 days for the TAPP group, respectively. Patients after TAPP repair reported more frequent of a reduced physical mobility (p=0.019), and paraesthesia, like „feeling of the mesh“ (p=0.026), compared with patients after Lichtenstein repair. Feeling of pain impaired performances of daily living and work only slight in both groups (score 1 (no influence) -5 (highly influence), median: 2 (slight) in boths groups, p=0.223). There were no differences of limitations of slight, moderate or heavy performances of daily living (p>0.05).

Conclusion: Patients after Lichtenstein operation showing a significant reduction of inguinal pain compared to preoperative feeling. One months after hernia repair there are no significant differences in terms of limitations of daily living and ability to work comparing both groups.